Omitting elective nodal irradiation and irradiating postinduction versus preinduction chemotherapy tumor extent for limited-stage small cell lung cancer

Interim analysis of a prospective randomized noninferiority trial

Authors

  • Xiao Hu MD,

    1. Department of Radiation Oncology, Cancer Center, Sun Yat Sen University, Guangzhou, People's Republic of China
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    • The first 3 authors contributed equally to this article.

  • Yong Bao MD,

    1. Department of Radiation Oncology, Cancer Center, Sun Yat Sen University, Guangzhou, People's Republic of China
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    • The first 3 authors contributed equally to this article.

  • Li Zhang MD,

    1. Department of Medical Oncology, Cancer Center, Sun Yat Sen University, Guangzhou, People's Republic of China
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    • The first 3 authors contributed equally to this article.

  • Ying Guo MD,

    1. Good Clinical Practice, State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat Sen University, Guangzhou, People's Republic of China
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  • Yuan Yuan Chen MD,

    1. Department of Radiation Oncology, Cancer Center, Sun Yat Sen University, Guangzhou, People's Republic of China
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  • Kai Xin Li MD,

    1. Department of Radiation Oncology, People's Liberation Army 180 Hospital, Quanzhou, People's Republic of China
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  • Wei Hua Wang MD,

    1. Radiation Therapy Center, Kiang Wu Hospital, Macau, People's Republic of China
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  • Yuan Liu MD,

    1. Department of Radiation Oncology, Affiliated Tumor Hospital of Guangzhou Medical College, Guangzhou, People's Republic of China
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  • Han He MD,

    1. Department of Radiation Oncology, The First People's Hospital of Foshan City, Foshan, People's Republic of China
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  • Ming Chen MD

    Corresponding author
    1. Department of Radiation Oncology, Cancer Center, Sun Yat Sen University, Guangzhou, People's Republic of China
    • Department of Radiation Oncology, Cancer Center, Sun Yat Sen University, 651 Dongfeng Rd E, Guangzhou 510060, People's Republic of China

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Abstract

BACKGROUND:

Controversies exist with regard to thoracic radiotherapy volumes for limited-stage small cell lung cancer (SCLC). This study compared locoregional progression and overall survival between limited-stage SCLC patients who received thoracic radiotherapy to different target volumes after induction chemotherapy.

METHODS:

Chemotherapy consisted of 6 cycles of etoposide and cisplatin. After 2 cycles of etoposide and cisplatin, patients were randomly assigned to receive thoracic radiotherapy to either the postchemotherapy or prechemotherapy tumor extent as study arm or control. Elective nodal irradiation was omitted for both arms. Forty-five Gy/30Fx/19 days thoracic radiotherapy was administered concurrently with cycle 3 chemotherapy. Prophylactic cranial irradiation was administered to patients who achieved complete remission. An interim analysis was planned when the first 80 patients had been followed for at least 6 months, for consideration of potential inferiority in the study arm.

RESULTS:

Forty-two and 43 patients were randomly assigned to a study arm and a control, respectively. The local recurrence rates were 31.6% (12 of 38) and 28.6% (12 of 42), respectively (P = .81). The isolated nodal failure rates were 2.6% (1 of 38) and 2.4% (1 of 42), respectively (P = 1.00). All isolated nodal failure sites were in the ipsilateral supraclavicular fossa. Mediastinal N3 was the only factor to predict isolated nodal failure (P = .004; odds ratio [OR], 29.33; 95% CI, 2.94-292.38). One-year and 3-year overall survival rates were 80.6%, 36.2%, and 78.9%, 36.4%, respectively (P = .54).

CONCLUSIONS:

Preliminary results indicated that irradiated postchemotherapy tumor extent and omitted elective nodal irradiation did not decrease locoregional control in the study arm, and the overall survival difference was not statistically significant between the 2 arms. Further investigation is warranted. Cancer 2012;. © 2011 American Cancer Society.

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